application for provident benefits (apb) - Pag-Ibig Fund

o MEMBERSHIP MATURITY
o OPTIONAL WITHDRAWAL
o RETIREMENT
Effective Date of Retirement _
Last Day of Service========
APPLICATION FOR PROVIDENT
BENEFITS (APB) CLAIM
REASON FOR CLAIM (Check appropriate box)
o SEPARATION FROM SERVICE DUE
TO HEALTH REASONS
o TOTAL DISABILlTYIiNSANITY
Nature of Illness _
o PERMANENT DEPARTURE FROM
THE COUNTRY
o DEATH
Date of Death _
...• .." ..... "
HQP·PFF·040
APPLICATION No. J
'--~
o OTHERS
Please Specify _
o MODIFIED
•••••••••• Em~·.·
Pag-IBIG II (MP2) 0 Pag-IBIG OVERSEAS PROGRAM (POP)
••••••••••••••
LAST NAME FIRST NAME NAME EXTENSION (e.g., Jr., II) MIDDLE NAME Pag-IBIG MID NoJRTN
MOTHER'S LAST NAME BEFORE MARRIAGE (For Married Female Only)
DATE OF BIRTH (mm/dd/yyyy)
CLAIMANT, if other than Member (Last Name, First Name, Name Extension, Middle Name RELATIONSHIP TO MEMBER
•
MEMBER'S PRESENT HOME ADDRESS
Unit/Room No., Floor Building Name Lot No., Block No., Phase No. House No. Street Name
Subdivision
CONTACT DETAILS (Indicate country code if abroad)
COUNTRY + AREA CODE TELEPHONE NUMBER
Home
Barangay Municipality/City Province/State/Country (if abroad) ZIP Code 1 11 _
CLAIMANTS PRESENT HOME ADDRESS (Leave blank if the same as member)
Unit/Room No., Floor Building Name Lot No., Block No., Phase No. House No. Street Name Subdivision
Barangay Municipality/City Province/State/Country (if abroad) ZIP Code
Cell Phone
EMPLOYMENT HISTORY FROM DATE OF Pag-IBIG MEMBERSHIP (Use another sheet if necessary)
NAME OF EMPLOYER/BUSINESS ADDRESS
AUTHORITY TO CREDIT
IN THE EVENT OF THE APPROVAL OF MY APPLICATION FOR PROVIDENT BENEFITS CLAIM, I
HEREBY AUTHORIZE Pag-IBIG Fund TO CREDIT MY CLAIM PROCEEDS TO MY LANDBANK
ACCOUNT OR CASH CARD THAT I HAVE INDICATED BELOW
PAYROLL ACCOUNTIDISBURSEMENT I BANK'S ADDRESS
CARD NO.
1 11 _
Email Address
1'----__ -
DATE OF Pag-IBIG MEMBERSHIP
FROM (MonthlYear) I TO (MonthlYear)
I
AUTHORITY TO TRANSFER
(For matured savin sunder Pa -IBIG II/Pag-IBIG Overseas Pro ram)
IN THE EVENT OF THE APPROVAL OF MY APPLICATION FOR PROVIDENT BENEFITS
CLAIM, I HEREBY AUTHORIZE Pag-IBIG Fund TO TRANSFER MY CLAIM PROCEEDS TO MY
MP2 ACCOUNT THAT I HAVE INDICATED BELOW
MP2 ACCOUNT NO. I AMOUNT TO BE TRANSFERRED
o Full Amount 0 Partial Amount P _
SIGNATURE OF MEMBER DATE SIGNATURE OF MEMBER DATE
APPLICATION AGREEMENT
I hereby certify that I have read and understood the contents hereof, including the guidelines and instructions indicated at the back portion of
this form. I further certify under pain of perjury that all information I have indicated herein are true and correct to the best of my knowledge and
belief, and that my signature or thumbmark appearing herein is genuine and authentic. I likewise understand that the processing of this
application is subject to pertinent provisions of the implementing rules and regulations of the Pag-IBIG Fund. In the event of any outstanding
Pag-IBIG loan, Pag-IBIG Fund is hereby authorized to withhold, in whole or in part, the provident benefit subject of this claim, and apply the
same as payment to the said loan as well as other obligations due to the Pag-IBIG Fund as of the date of this application.
I hereby waive my rights under R.A. No. 1405 and authorize Pag-IBIG Fund to verify/validate my payroll bank account number.
MEMBERICLAIMANT
(Signature over Printed Name)
THIS PORTION IS FOR Pag-IBIG FUND USE ONLY
PARTICULARS DETAILS
PROVIDENT BENEFITS CLAIM DV/CHECK NO. DATE FILED
Pag-IBIG LOANS AVAILED DVNO. CHECK NO. OUTSTANDING BALANCE AS OF
MULTI-PURPOSE/CALAMITY LOAN
HOUSING LOAN
PAYEE/S
HL ACCOUNT NO. TAKEOUT DATE OUTSTANDING BALANCE AS OF
COMPUTATION OF AMOUNT DUE TO MEMBER
DETAILS AMOUNTS PAYABLE REMARKS
EMPLOYEE'S/MEMBER'S TOTAL CONTRIBUTION l'
EMPLOYER'S TOTAL CONTRIBUTION
TOTAL DIVIDENDS EARNED
TOTAL ACCUMULATED VALUE (TAV) l'
LESS: OUTSTANDING LOAN BALANCE
NET AMOUNT l'
DEATH BENEFIT
TOTAL AMOUNT DUE TO MEMBER l'
TH/S FORM MAY BE REPRODUCED. NOT FOR SALE
I
I
I
THUMB MARKS OF MEMBER/CLAIMANT
(If unable to sign)
LEFT THUMB RIGHT THUMB
(To be done In the presence of Pag-IBIG Fund Personnel)
(Signature over Printed Name of Witness) Date
REMARKS
COMPUTED BY DATE
REVIEWED BY DATE
APPROVED BY DATE
DISAPPROVED BY DATE
(t-cevtsea i tran. j

A. When to File
GUIDELINES AND INSTRUCTIONS
The Application for Provident Benefits Claim (APB [HOP-PFF-040J) may be filed upon the occurrence of any of the following:
1. Membership Maturity - a period of not less than 20 years commencing from the 1st day of the month to which the member's initial contribution to the Fund applies, provided
that the member has actually contributed a total of 240 monthly contributions to the Fund at the time of maturity;
2. Optional Withdrawal of Pag-IBIG Savings - allowed for members who registered under RA No. 7742, as well as members who voluntarily joined the Fund under E.O. No. 90.
Partial withdrawal of savings may be made after 10 or 15 years of continuous membership from January 1995. For members who registered under R.A. No. 9679 shall have
the option to withdraw his or her Total Accumulated Value (TAV) on the fifteenth (15 th ) year of continuous membership. Provided, a member has no outstanding loan with the
Fund. This option may be exercised only once during the membership term.
3. Retirement - a member shall be compulsorily retired under the Fund upon reaching age sixty-five (65). He may, however, opt to retire earlier under the Fund upon the
occurrence of any of the following:
a. his actual retirement from the SSS, GSIS or separate employer provident/retirement plan, provided, however, that under the latter case, the member has at least reached
age forty-five (45).
b. notwithstanding his continued employment or service, upon reaching age sixty (60), provided he is not a member-borrower;
4. Total Disability or Insanity - loss or impairment of a physical or mental function resulting from injury or sickness which completely incapacitates a member to perform any work
or engage in any business or occupation as determined by the Fund;
5. Separation from the service due to health reasons;
6. Permanent Departure from the Philippines;
7. Death.
B. Who May File
The application may be filed by the member, his guardian, or any authorized representative/so If the reason for claim is death of the member, the application may be filed by his
heir/s or the latter's representative/s, or any appointed court administrator or executor.
In all instances wherein Application for Provident Benefits (APB) Claim is filed by an authorized representative, the Special Power of Attorney (HOP-PFF-033) and the
identification cards of both the member and his/her representative/s shall be presented and/or submitted.
C. Payment of Benefits
1. Amount
The Provident Benefits of a member shall consist of his Total Accumulated Value (TAV) , which includes the member's personal contributions to the Fund, his employer's
counterpart contribution, if applicable, and the dividend earnings of the total contributions declared by Pag-IBIG Fund.
2. Application ofTAV
In the event of membership termination, the outstanding balance of the member's Short-Term Loan (STL) shall be deducted from his TAV. Likewise, the outstanding balance of
the member's housing loan shall be deducted from his TAV, unless the guidelines prevailing at the time of loan takeout provided otherwise.
Borrower/s who opt to continue amortizing the housing loan balance shall be required to continue paying the monthly membership contribution in accordance with the terms and
conditions of the Promissory Note or Loan and Mortgage Agreement (PN/LMA) until the loan obligation is fully settled.
For accounts taken out under the UHLP Multi-Window Lending System, the foltowing shall apply:
a. Upon termination of the borrower's membership which entitles him to the benefits as provided for under the rules of the SSS, GSIS, and Pag-IBIG, the TAV to be received
by the borrower shall be applied to his outstanding housing loan.
In case of death, the provision of the borrower's Mortgage Redemption Insurance (MRI) shall apply, and if an unpaid balance remains, the borrower's TAV or death benefits
shall be applied in payment thereof, subject to the existing policies, rules and regulations.
b. Upon the occurrence of an event of default, the lending window or its assignee/transferee may apply any of the borrower's funds in the possession of the lending window or
its assignee/transferee in full or partial payment of the borrower's obligations as stated in the LMA and Promissory Note.
For this purpose, the LMA provides further that the borrower authorizes the lending window or its assignee/transferee to secure and apply without prior notice to the borrower
any fund belonging to him in the possession or control of the lending window or its assignee/transferee.
3. Manner of Payment
For claims due to membership maturity, the benefits shall be paid either by check directly to the member or deposited to the member's payrof bank account.
For claims other than membership maturity, the benefits shall be made directly to the member, his guardian or any authorized representative, provided that, in the event of
death of a member, payment shall be made to his heir/s or the latter's guardian/authorized representative/s, or any duly appointed court administrator or executor.
Should there be any contributions due the member but not yet received by the Fund at the time of the above payment, the same shall be correspondingly released after receipt
of the unremitted contributions.
LIST OF REQUIRED DOCUMENTS
REQUIREMENTS MM OW R 55 TO PO 0 Remarks
1. Notarized Certificate of Early Retirement (For Private Emp/oyee, at least 45 years old) X
2. Updated Service Record (For Government Employee) X X X X X
3. Any of the following: (For Private/Government Employee)
·
X
National Statistic Office (NSO) Certified True Copy of Member's Birth Certificate'
· SSS Retirement Voucher (For Private Emp/oyee)IGSIS Retirement Voucher (For Government Employee)
· Valid 10 card with photo and signature or 2 valid ID cards stating date of birth
4. Order of Retirement } X
5. Updated Statement of Service (For AFP, Phil. Navy & Phil. Army personnel) X X
6. Statement of Last Payment X X
7. Physician's CertificatelStatement X
8. Notarized Sworn Employer's Certification that the Member was separated from service due to health
X
reasons
9. Latest SSS Disability Voucher (For Private Emp/oyee) X
10. Ph ysician's Certificate or Statement of Insanity X
11. SSS Total Disability Voucher X
12. Compuls ory Disability Discharge (COD) Order (For AFP, Phil. Navy & Phil. Army Personnel) X
13. Photocopy of Passport X
14. Nota rized Sworn Declaration of Intention to Depart from the Philippines Permanently [HOP-PFF-031] X
15. Any of the following: X
· Immigrant Visa;or . Settlement Visa; or
· Residence Visa; or . Such other equivalent document depending on the issuing country
16. NSO Certified True Copy of Member's Death Certificate X
17. Nota rized Proof of Surviving Legal Heirs [HOP-PFF-030] X
18. To establish kinship to the deceased member, the claimant shall submit any of the following: X
· NSO Certified True Copy of Member's/Claimant's Birth Certificate; or
· NSO Certified True Copy of Member's Marriage Contract (If member is married); or
· Certified True Copy of Member'sIClaimant's BaptismallConfirmation Certificate
· Certificate of No Marriage (CENOMAR) (For Single Only)
19. NSO Certified True Copy of Birth Certificate* of all Children (if any) or Baptismal/Confirmation Certificate X
20. Nota rized Affidavit
[HQP-PFF-028]
of Guardianship (For children 18 years old and below, or physicallylmentally incompetent)
X
21. Funeral Receipt X
22. Two (2) valid 10 cards with signature and photo of claimant X X X X X X X
23. POP Passbook (For POP Members only) X
24. Special Power of Attorney [HOP-PFF-033] (If member cannot claim personally) X X X X X X
25. Certification of ForeclosurelDacion En Pago issued by the Foreclosure Department (If applicable)
26. 'NSO Certified True Copy of Non-Availability of Birth Record of Member together with any of the ff:
·
X X
Notarized Joint Affidavit of Two (2) Disinterested Persons [HOP-PFF-029]; or
· Photocopy of two (2) valid ID cards or any document indicating member's date of birth
27.0thers
Pag-IBIG Fund reserves the right to request additional documents if deemed necessary.
IMPORTANT:
1 PROCESSING OF CLAIMS SHALL COMMENCE ONLY UPON SUBMISSION OF COMPLETE DOCUMENTS.
2. IN ALL INSTANCES WHEREIN PHOTOCOPIES ARE SUBMITIED, THE ORIGINAL DOCUMENTS SHALL BE PRESENTED FOR AUTHENTICATION.
LEGEND: MM
OW
Membership Maturity
Optional Withdrawal
R
SS
Retirement
Separation from the Service Due to Health Reason
TD
PD
D
Total Disability/lnsanity
Penmanent Departure from the country
Death